Climbing Miller's Pyramid: Operationalizing competency-based undergraduate nursing education using the 2021 essentials

The 2021 and 2026 editions of The Essentials: Core Competencies for Professional Nursing Education ( Essentials ) published by the American Association of Colleges of Nursing (AACN), call for a transformational shift toward competency-based nursing education grounded in observable performance. This article describes a comprehensive redesign of a Level I (prelicensure), four semester, nursing curriculum integrating each of the AACN sub-competencies using backward design and Miller's Pyramid as the developmental organizing framework. A multidisciplinary task force aligned program outcomes and conceptual frameworks to create a coherent, developmentally sequenced curriculum across didactic, simulation, and clinical learning environments. Signature assignments, Objective Structured Clinical Experiences (OSCEs), and unfolding case studies were developed to assess “shows how” and “does” competencies, providing standardized indicators of student progression. The redesign process emphasized structured transparency, faculty engagement, feedback cycles, and iterative refinement to ensure feasibility and adoption. Skilled project management, as well as guidance from instructional designers and clinical partners, was critical to achieving redesign goals. This approach offers a replicable model for operationalizing competency-based education by explicitly linking competency level to curricular structure, thereby enhancing transparency, coherence, and the ability to demonstrate progression toward practice readiness.